Abstract
Objective. The aim of our prospective study was to investigate the applicability and the diagnostic value of near-infrared spectroscopy (NIRS) in SAH patients using the cerebral oximeter INVOS 5100C. Methods. Measurement of cerebral oximetry was done continuously after spontaneous SAH. Decrease of regional oxygen saturation (rSO2) was analyzed and interpreted in view of the determined intrinsic and extrinsic factors. Changes of rSO2 values were matched with the values of ICP, tipO2, and TCD and the results of additional neuroimaging. Results. Continuous measurement of rSO2 was performed in nine patients with SAH (7 females and 2 males). Mean measurement time was 8.6 days (range 2–12 days). The clinical course was uneventful in 7 patients without occurrence of CVS. In these patients, NIRS measured constant and stable rSO2 values without relevant alterations. Special findings are demonstrated in 3 cases. Conclusion. Measurement of rSO2 with NIRS is a safe, easy to use, noninvasive additional measurement tool for cerebral oxygenation, which is used routinely during vascular and cardiac surgical procedures. NIRS is applicable over a long time period after SAH, especially in alert patients without invasive probes. Our observations were promising, whereby larger studies are needed to answer the open questions.
Highlights
Delayed cerebral ischemia (DCI) is the major cause of morbidity and mortality in patients suffering from spontaneous subarachnoid hemorrhage (SAH)
digital subtraction angiography (DSA) revealed an aneurysm as the source of hemorrhage in 7 patients (three aneurysms of the anterior communicating artery (ACoA), one middle cerebral artery (MCA) aneurysm, one aneurysm of the posterior cerebral artery (PCA), and one aneurysm of the pericallosal artery)
The bleeding source was unclear in one case after DSA (SAH of unknown origin)
Summary
Delayed cerebral ischemia (DCI) is the major cause of morbidity and mortality in patients suffering from spontaneous subarachnoid hemorrhage (SAH). Diverse therapeutically approaches have focussed bedside brain monitoring for early detection of hypoperfusion of the brain. It is the measurement of intracerebral pressure (ICP), partial tissue oxygenation (tipO2), regional cerebral blood flow using thermal diffusion flowmetry and micro-dialysis—being invasive measurement method. As a noninvasive measurement tool one or two channel EEG adhesive electrodes are used to monitor the sedation depth [2, 11,12,13] As another noninvasive but discontinuous bedside measurement method transcranial Doppler (TCD) is available, with well-known deficits like investigator dependence and weak correlation of elevated blood flow velocity and symptomatic CVS [14, 15]
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